Scribd Logo
Upload

Welcome to Scribd!

  • Pfizer Membership Form

    Uploaded by

    jasfer
    354 views1 page
    This document is a membership form for the Pfizer Sulit Patient Care Program. It requests contact information from the applicant such as phone numbers and email. It also asks for a copy of a government ID and the applicant's doctor's details to match any prescriptions. By signing, the applicant agrees to the terms and conditions of Pfizer's patient care program to receive continued free membership benefits like using the Pfizer Sulit card.

    Original Description:

    Application form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a membership form for the Pfizer Sulit Patient Care Program. It requests contact information from the applicant such as phone numbers and email. It also asks for a copy of a government ID and the applicant's doctor's details to match any prescriptions. By signing, the applicant agrees to the terms and conditions of Pfizer's patient care program to receive continued free membership benefits like using the Pfizer Sulit card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    354 views1 page

    Pfizer Membership Form

    Uploaded by

    jasfer
    This document is a membership form for the Pfizer Sulit Patient Care Program. It requests contact information from the applicant such as phone numbers and email. It also asks for a copy of a government ID and the applicant's doctor's details to match any prescriptions. By signing, the applicant agrees to the terms and conditions of Pfizer's patient care program to receive continued free membership benefits like using the Pfizer Sulit card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Pfizer Sulit Card No.

    This serves as your membership form to the Pfizer Sulit


    Patient Care Program. Complete and sign the form and mail /
    fax / email back for your continued FREE membership and
    benefits like the usage of the Pfizer Sulit card.
    Mail to: P.O Box 1139 Makati Central Post Office 1252 Makati City Philippines
    Email: Pfizerclub@pfizer.com
    Fax: Metro Manila 672 2000
    Provincial Toll free 1800 10 672 2000
    Please attach 1 copy of any Government Issued ID

    Contact Details:
    Mobile Phone Number:
    Home Phone Number:
    Office Phone Number:
    Email Address:
    IMPORTANT: Your doctor’s details below should coincide with
    your prescription:

    By signing, I certify that the information given is true and correct. My enrollment
    and / or use of the Sulit card shall be deemed my acceptance and agreement with
    the terms and conditions of the Pfizer Sulit Patient Care Program as specified in
    the enrollment form or Pfizer website.
    PP-PCP-PHL-0031

    Working together for a healthier world.

    You might also like